柯萨奇病毒感染及T淋巴细胞亚群的改变与1型糖尿病的关系研究

Association of coxsackie virus infection and T lymphocyte subset changes with type 1 diabetes

目的探讨柯萨奇病毒感染与1型糖尿病的关系,及T淋巴细胞亚群改变在病情发生发展中的作用。方法选取新发糖尿病患者(Ⅰ组)22例,发病一段时间后的患者(Ⅱ组)30例,正常对照组(Ⅲ组)30例,RT-PCR法检测血中柯萨奇病毒RNA,流式细胞术检测T淋巴细胞亚群的变化。结果柯萨奇病毒RNA的阳性率Ⅰ组患者为55.55%,Ⅱ组患者为23.33%,Ⅲ组为6.67%,χ2检验显示P<0.01,差异具有显著统计学意义;Ⅰ组患者中有上呼吸道感染者较无上呼吸道感染者,CVB-RNA的阳性率明显升高,χ2检验显示P<0.05,差异具有显著性。Ⅰ、Ⅱ组患者T淋巴细胞亚群与对照组相比,CD3和CD4的百分率下降,CD4/CD8的比值也降低,差异有统计学意义(P<0.01或P<0.05);但Ⅱ组CD3、CD4及CD4/CD8均较Ⅰ组有上升趋势,其中CD3和CD4的百分率两组差异有统计学意义(P<0.01或P<0.05);CVBRNA阳性组与对照组相比,CD3、CD4、CD8及CD4/CD8均降低,且差异有统计学意义(ΔP<0.01或ΔP<0.05),CVBRNA阳性组与阴性组相比,CD3、CD4、CD8及CD4/CD8也均降低,有显著差异性(P<0.05或P<0.01)。结论 1型糖尿病的发生发展与柯萨奇病毒感染有关,T淋巴细胞亚群的改变可能是其致病机制之一。

Objective To investigate the relationship between coxsackievirus infection and type 1 diabetes mellitus （T1DM）,and observe the changes of T lymphocyte subsets in the development of T1DM. Methods We detected Coxsackievirus RNA by reverse transcription PCR,and measured the change in T-lymphocyte subsets by flow cytometry in 22 cases of newly diagnosed T1DM （group I）,30 patients with diabetes for some time （group II）,and 30 healthy subjects （group III）. Results The positivity rate of coxsackie virus RNA in groups I,II,and III was 55.55%,23.33%,and 6.67%,respectively,showing a significant difference among the 3 groups （P0.01）. Patients with upper respiratory tract infection had a higher positivity rate for coxsackie virus RNA than those without upper respiratory tract infection in group I （P0.05）. Compared with the control group,the percentage of CD3,CD4 and CD4/CD8 ratio decreased significantly in groups I and II （P0.01 or P0.05）. CD3,CD4 and CD4/CD8 tended to increase in group II in comparison with group I,and there was an significant difference in CD3 and CD4 between the two groups （P0.01 or P0.05）. Compared with the control group and CVBRNA-negative group,CVBRNA-positive group showed significantly lowered CD3,CD4,CD8 and CD4/CD8 （P0.01 or P0.05）. Conclusion The occurrence and development of type 1 diabetes is closely related to coxsackie virus infection,and the changes in T lymphocyte subsets serves as a probable mechanism of its pathogenicity.